Cardiology - 'bad medicine' or medicine as it should be?
In reference to the recent view shared by Dr Spence regarding the
supposed over treatment of cardiovascular disease and preventative
strategies in Cardiology, working within the field my initial retort is
based on a few simple epidemiological facts; the rates of obesity have
increased by 400% over the last 25 years in the UK, with the the 2004
House of Commons Health Committee Report suggesting up to two-thirds of
the population are now clinically obese, which is consequently causing a
surge in the incidence of diabetes and the associated micro- and macro-
vascular complications, including an increased prevalence of coronary
artery disease, which, worryingly, is afflicting a younger age range.
Cardiovascular interventions, whether pharmacologic or device related
frequently undergo prospective randomized-control trial assessment of
their efficacy and safety, to the degree which is often lacking in many
other fields in medicine. This rigidity in demanding that only research
proven therapies are included into clinical practice enables 'best medical
practice' to be adopted by clinicians, which perpetuates a continuous
improvement in outcomes. Furthermore, this foundation in research allows
bodies such as the European Society of Cardiology or American College of
Cardiology to develop clinical management frameworks based solely on the
demonstrated clinical efficacy of the various therapies. To suggest that
clinical decisions are more often than not based on the vested interest of
'commercial opportunity' is simply inappropriate.
Finally, developing and widening primary prevention strategies in an
attempt to minimise coronary artery disease related morbidity and
mortality is one of the most important long-term mechanisms required to
combat the problem. Though the value of more aggressive strategies, such
as routine statin therapy for those aged over 50, is unclear at this
stage, it could be argued that adopting a pragmatic approach to a problem
with such a healthcare burden may be needed to provide important benefits
in the long term.
Rapid Response:
Cardiology - 'bad medicine' or medicine as it should be?
In reference to the recent view shared by Dr Spence regarding the
supposed over treatment of cardiovascular disease and preventative
strategies in Cardiology, working within the field my initial retort is
based on a few simple epidemiological facts; the rates of obesity have
increased by 400% over the last 25 years in the UK, with the the 2004
House of Commons Health Committee Report suggesting up to two-thirds of
the population are now clinically obese, which is consequently causing a
surge in the incidence of diabetes and the associated micro- and macro-
vascular complications, including an increased prevalence of coronary
artery disease, which, worryingly, is afflicting a younger age range.
Cardiovascular interventions, whether pharmacologic or device related
frequently undergo prospective randomized-control trial assessment of
their efficacy and safety, to the degree which is often lacking in many
other fields in medicine. This rigidity in demanding that only research
proven therapies are included into clinical practice enables 'best medical
practice' to be adopted by clinicians, which perpetuates a continuous
improvement in outcomes. Furthermore, this foundation in research allows
bodies such as the European Society of Cardiology or American College of
Cardiology to develop clinical management frameworks based solely on the
demonstrated clinical efficacy of the various therapies. To suggest that
clinical decisions are more often than not based on the vested interest of
'commercial opportunity' is simply inappropriate.
Finally, developing and widening primary prevention strategies in an
attempt to minimise coronary artery disease related morbidity and
mortality is one of the most important long-term mechanisms required to
combat the problem. Though the value of more aggressive strategies, such
as routine statin therapy for those aged over 50, is unclear at this
stage, it could be argued that adopting a pragmatic approach to a problem
with such a healthcare burden may be needed to provide important benefits
in the long term.
Competing interests: No competing interests